Management of Dysphonia in Patients with Cancer History

Initial Evaluation

• For a patient with dysphonia and a history of cancer, the American Academy of Otolaryngology-Head and Neck Surgery recommends against ordering an MRI prior to visualization of the larynx, and instead suggests performing laryngoscopy or referring to a clinician who can perform laryngoscopy to directly visualize the larynx first 1, 2
• Dysphonia in a patient with cancer history requires prompt evaluation due to increased risk of serious underlying pathology, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3, 4
• The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends expedited laryngeal evaluation in patients with a history of cancer 4, 5

Diagnostic Approach

• Laryngoscopy is the cornerstone of diagnosis and should be performed before any advanced imaging, according to the American Academy of Otolaryngology-Head and Neck Surgery 2, 5
• Direct visualization via laryngoscopy allows for identification of vocal fold lesions, paralysis, or other laryngeal pathology 6
• Advanced imaging, such as CT or MRI, should only be considered after laryngoscopy has been performed, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2, 7

Rationale for Laryngoscopy

• Ordering MRI before laryngoscopy is explicitly recommended against in clinical practice guidelines by the American Academy of Otolaryngology-Head and Neck Surgery 2, 7
• Laryngoscopy provides direct visualization and is more cost-effective as the initial diagnostic approach, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
• Delayed otolaryngology referral (>3 months) more than doubles healthcare costs and may delay appropriate diagnosis, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 2

Special Considerations

• Patients with a history of cancer require expedited evaluation due to higher risk of recurrence or new primary malignancies, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3, 4
• If laryngoscopy reveals concerning findings, then appropriate imaging can be ordered based on those specific findings, according to the American Academy of Otolaryngology-Head and Neck Surgery 7
• Documenting resolution, improvement, or worsening of symptoms after evaluation and treatment is recommended by the American Academy of Otolaryngology-Head and Neck Surgery 8, 5